Annals for Hospitalists - July 2022
Authors: Megan Mack, Matthew Luzum, David H. Wesorick
Journal: Annals of Internal Medicine (2022)

Web ExclusivesJuly 2022Annals for Hospitalists - July 2022FREEMegan Mack, MD*, Matthew Luzum, MD* and David H. Wesorick, MDMegan Mack, MD*From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)Search for more papers by this author, Matthew Luzum, MD*From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)Search for more papers by this author and David H. Wesorick, MDFrom Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AWHO202207190 SectionsAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Inpatient NotesUnderstanding the 2021 Surviving Sepsis Campaign Guidelines Recommendations on Fluid Resuscitation in Sepsis—Elizabeth S. Munroe, MD, and Hallie C. Prescott, MD, MScIn this commentary, the authors demystify the resuscitation recommendations for patients with sepsis.Highlights of Recent Articles From Annals of Internal MedicineEvolving Practice Choices by Newly Certified and More Senior General Internists: A Cross-Sectional and Panel ComparisonAnn Intern Med. 2022;175:1022-1027. Published 17 May 2022. doi:10.7326/M21-4636This study examined the trends in career choice over time (determined by Medicare billing data) for nonspecializing general internists who were certified between 1990 and 2017. From 2008 to 2018, the proportion of general internists practicing as hospitalists increased (from 25% to 40%), as did the proportion practicing as outpatient-only physicians (from 23% to 38%), whereas the proportion in mixed practices decreased (from 52% to 23%). Most of the mixed-practice physicians migrated to outpatient-only practices, whereas most newly certified physicians chose hospital medicine. By 2018, 71% of newly certified general internists practiced as hospitalists, with only 8% practicing as outpatient-only physicians.Key points for hospitalists include:At present, most newly certified general internists are choosing hospital medicine over outpatient care. During the past decade, many senior physicians have moved from mixed practices to outpatient-only practices.The authors hypothesize that the effect of low numbers of newly certified internists choosing outpatient-only care has been blunted by the substantial movement of senior internists into this space. However, with very few remaining physicians moving in this direction, the primary care shortage is likely to become even more apparent.Cardiovascular Outcomes in Patients Initiating First-Line Treatment of Type 2 Diabetes With Sodium–Glucose Cotransporter-2 Inhibitors Versus Metformin: A Cohort StudyAnn Intern Med. 2022;175:927-937. Published 24 May 2022. doi:10.7326/M21-4012This cohort study used propensity matching in several insurance databases to evaluate treatment-naive patients with type-2 diabetes who were initiated on either a sodium–glucose cotransporter-2 inhibitor (n = 8613) or metformin (n = 17 226) and compared cardiovascular outcomes over a mean follow-up of 12 months. Risk for myocardial infarction/stroke/mortality was similar between the groups, but the sodium–glucose cotransporter-2 inhibitor group demonstrated a lower risk for heart failure hospitalization (hazard ratio, 0.78 [95% CI, 0.63 to 0.97]) and a higher risk for genital infections (hazard ratio, 2.19 [CI, 1.91 to 2.51]).Key points for hospitalists include:This study shows that, compared with metformin, initial sodium–glucose cotransporter-2 inhibitor treatment is associated with similar rates of myocardial infarction/stroke/mortality and reduced rates of heart failure hospitalization.The authors acknowledge that a randomized trial would be a superior design for comparing the cardiovascular outcomes of these medications. However, they note that no such trials are forthcoming and, for now, providers may need to rely on cohort studies like this one to understand the relative benefits of promising new medications.A Longitudinal Study of COVID-19 Sequelae and Immunity: Baseline FindingsAnn Intern Med. 2022;175:969-979. Published 24 May 2022. doi:10.7326/M21-4905This cohort study compared a group of self-selected COVID-19 survivors (n = 189, 55% with symptoms consistent with postacute sequelae of SARS-CoV-2 infection [PASC]) to a control group of patients without SARS-CoV-2 infection (n = 120, 13% with symptoms consistent with PASC). The most common symptoms of PASC were fatigue, dyspnea, anosmia/parosmia, concentration impairment, and headache. The only significant risk factors for developing PASC were female sex and a self-reported history of anxiety. Extensive diagnostic evaluation (including history and physical examination, neurocognitive assessment, mental health questionnaires, pulmonary function testing, 6-minute walk test, echocardiography, and bloodwork [including tests of systemic inflammation/immune activation]) revealed no specific cause of the symptoms in most cases.Key points for hospitalists include:Some patients develop PASC after acute SARS-CoV-2 infection. In most cases, objective testing is normal in these patients, and the pathogenesis of these symptoms remains unclear.Despite the absence of objective findings, patients with PASC report significantly lower quality of life than either COVID-19 survivors without PASC or control participants.An editorialist cautions providers not to allow the lack of objective abnormalities to negate our patients' experiences and stresses the need for further study of these patients.The Latest Highlights From Journal ClubAre patients with nephrotic syndrome at increased risk for thromboembolic disease?Adults with first-time nephrotic syndrome had increased risk for thromboembolic events, higher near time of diagnosisAnn Intern Med. 2022;175:JC70. doi:10.7326/J22-0039This cohort study compared patients with newly diagnosed nephrotic syndrome with matched control participants to establish the risk for thromboembolism and bleeding over 10 years. Patients with nephrotic syndrome had significantly increased risk for thromboembolism and bleeding, especially in the first 30 days of follow up.Are COVID-19 survivors at increased risk for adverse mental health outcomes?Patients surviving COVID-19 had increased risk for adverse mental health outcomes vs. persons without COVID-19Ann Intern Med. 2022;175:JC69. doi:10.7326/J22-0031This Veterans Affairs cohort study compared mental health outcomes of 153 848 patients who survived COVID-19 to a contemporary cohort without COVID-19 and found that COVID-19 survivors were more likely to receive a mental health diagnosis at 30-day follow-up (12% vs. 8.4%) and that the risk was significantly higher for those patients who were hospitalized with COVID-19 (26% vs. 8.5%).Sign up here to have Annals for Hospitalists delivered to your inbox each month. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)Disclosures:Authors have reported no disclosures of interest. Forms can be viewed at http://www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-3315.* The authors contributed equally to the article. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals for Hospitalists Inpatient Notes - Understanding the 2021 Surviving Sepsis Campaign Guidelines Recommendations on Fluid Resuscitation in Sepsis Elizabeth S. Munroe and Hallie C. Prescott Metrics July 2022Volume 175, Issue 7Page: HO7 ePublished: 19 July 2022 Issue Published: July 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.Loading ...